P
1 de maio, 2022

Hints for HEDIS® (and more)

This month’s Hints for HEDIS is for Osteoporosis Management in Women who Had a Fracture (OMW).

Measure overview: Women 67 to 85 years of age who suffered a fracture anytime between 1 de julho, 2021 and 30 de junho, 2022 and who had a bone mineral density (BMD) test or a prescription for a drug to treat osteoporosis in the six months after the fracture. 

A key takeaway for this measure is the time-sensitive nature of the required follow-up after a fracture. Members who experienced a fracture should either have a BMD test or a prescription to treat osteoporosis within six months of the fracture date.

Please note: Fractures of a finger, toe, any part of the face or skull will not be included in this measure. Please refer to your 2022 PQIP booklet for a complete list of exclusions for this measure.

 What you can expect from BCBSRI: 

  • A monthly fax notification of new fractures for any of our members in your patient panel.
  • A notification to the member with instructions on how to follow-up after a fracture.
  • BCBSRI can help facilitate a convenient in-home heel scan for your patient with our partner, Signify Health, at no cost to the member.
  • A BCBSRI quality concierge nurse will be available to help answer your questions and assist your patient in following up post-fracture. 

Helpful reminder: If the member had a BMD (bone mineral density) test during the 24 months prior to the fracture date, they will be excluded from this measure. Members will also be excluded if they had a prior claim/encounter for osteoporosis therapy during the 12 months prior to the fracture date.

Codes to close the gap 

quality

 

Table A: CPT and HCPCS Codes to Identify BMD Tests and Medications for Osteoporosis Treatment 

 

Helpful reminder: This measure often has a small denominator. Because of this small patient pool, ensuring this gap is closed for any members in your patient panel can significantly improve your quality scores. It may be helpful to set reminders to follow-up with your patient post-fracture if you have not done so already. 

Authored by Isabel Villanis, BSN, RN | Please refer to your 2022 PQIP Booklet for additional information on this measure. Please do not hesitate to reach out to your Quality Representative with any questions at QualityHEDIS@bcbsri.org 
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